Liberty Shores Senior Living.

conclusion of the investigation. Per interview and record review, the facility conducted a thorough investigation and concluded that the injuries were related to the R1’s independent movement around the room (the R1 frequently moves around the room, moves furniture, and has a history of falls), and interventions were identified to help prevent further injury. No failed practice identified. 4) A record review of CRU intakes showed that a facility report related to the R1’s allegation of abuse was made on 08/13/2024 at 9:14 pm. Per interview, the facility administrator acknowledged that a facility report to the state complaint hotline was not made immediately as required. The facility failed to report an allegation of abuse as outlined in WAC 388.78A.2630(1)(a) and RCW 74.34.035. Conclusion / Action: Failed Provider Practice Identified / Citation(s) Written Failed Provider Practice Not Identified / No Citation Written N/A . Ii □ □ . Oct.24.2024 I :45PM lioerly Snores Assisted living No.1038 P. 5 Statement of Deficiencies License#: 1834 Compliance Determlnallon # 46758 Plan of Correction LIBERTY SHORES ASSISTED LIVING Completion Date Administrator (or Representative) WAC 388-78A-2630 Reporting abuse and neglect, (1) The assisted living facility must ensure that each staff person; (a) Makes a report to the department's Aging and Disability Services Administration Complaint Resolution Unit hotllne consistent with chapter 74.34 RCW In all cases where the staff person has reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred; and _This requirement was not met as evidenced by: . Based on interviews and record reviews. the facility failed to report allegations of abuse to the Department's Aging and Disability Services Administration Complaint Rssolution Unit hotline for 2 of 2 sampled residents (Resident 1 [R1] and Resident 2 [R2]), This failure to notify the Compliant Resolution Unit (CRU) placed 35 of 35 residents at risk of unreported abuse and prevented the Department from evaluating facility systems In place to protect residents. Findings Included ... RCW 74.32.035 Reports-Mandated and permlsslve-Contents-Confldentlallty. (1) When there is reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred, mandated reporters shall immediately report to the department. Record review of the facility's "Policy: Incident Reporting Guidelines" form, no date provided, showed that Liberty Shores has a zero-tolerance policy on any form of resident abuse, neglect. · abandonment, financial exploitation, and sexual and physical assault. As per RCW 74.34.035(1) when there is reasonable cause to believe abandonment, abuse, financial exploitation, or neglect of a resident has occurred, all mandated reporters are required to report the incident to the department of DSHS hotline number 1-800-562-6078. The report must be made within 24 hours from the time the determination was made that there Is reasonable cause to believe the reportable incident occurred. The number is available 24 hours a day, 7 days a week, and the date and time of the message is recorded. All employees of Liberty Shores and Harbor House are considered mandated reporters. When a mandated reporter has reason to suspect that an incident is sexual or physical assault, It should be reported to the local law enforcement agency (the Poulsbo Policy Department), and to the Department Hotline, and must be made immediately: Immediately means as soon as the resident is protected from further harm. . Oct.24.2024 I :46PM lioerly Snores Assisted living No.1038 P. 7 Statement of Oefiolenoies License#: 1834 Compliance Oetermlnallon # 46758 Plan of Correction LIBERTY SHORES ASSISTED LIVING Completion Date During an interview on 09/12/2024 at 11:16 a.m., Staff B, Administrator stated understanding of the requirement to immediately report allegations of abuse to the department. Plan/Attestation Statement I hereby certify that I have reviewed this report and have taken or will take active measures to correct this deficiency. By taking this action, LIBERTY SHORES ASSISTED LIVING Is or will be In compliance with this law and/ or regulation on (Dete) JI f 1 /1?,Q.;;,..'::[. I In addition, I will implement a system to monitor and ensure continued compliance with this requirement. L • Qb _J1,aAYR , , Administrator (or Representative) Date . Oct.24.2024 I :46PM lioerly Snores Assisted living No.1038 P. 8 Plan of Correction Agency Name Citation Date Submitted by Date of POC Submission Deanna HIise 10/24/2024 ·-,. Complaint Citation □ Certification Citation Citation: (list WAC) What initial or immediate On 9/5/2024 we immediately talked to all staff involved In the complaint regarding our actions policy to call the DSHS Hotline. We also set up an all staff mandatory meeting regarding were taken to address the importance of calling the hotline and keeping our residents safe on 9/19/2024 and concerns affecting clients? spoke to staff that could attend the Sept. 19th meeting one on one. We pa<ted more 3'B''8'-18A-J..<o3o Abuse/Hotline information throughout this facility New Resident right posters and every employee has the hotline call on the back of their name badges, We also added an extra online training in Relias for all employees How will you apply the We have added a class for all staff In house and any new staff hired will correction to all clients you be required to do the Mandated reporting training before working on the support? floor and will be added to our new hire Orientation requirements. Who will be responsible for Crystal Peterson- Director of HR services implementing changes and Aaron Melius-Maintenance Director monitor the corrections to They schedule and oversee all Training and New hire Orientation. ensure the problems do not reoccur? Date by which lasting Enter the date when you expect the lasting correction (including the correction will be achieved system to prevent future problems) to be complete. This must be within 45 days of the citation. 11/1/2024 Additional Information Our residents' safety is our number one priority, and we will do everything we need to correct this. Submit to RCS within 10 calendar days of receipt, please clearly indicate the name of the person who should receive your document. Region3: rcsrngion3email@dshs.wa.gov Tumwater Vancouver Lakewood 6639 Capital Blvd, SW 800 NE 136th Avenue, Suite 220 Lakewood, WA 98499 Tumwater, WA 98501 Vancouver, WA 98684 IDR Lacey Olympia, WA 98504-5600 RCSIDR@dshs.wa.gov

This document was prepared by Residential Care Services for the Locator website.